三维剪切波弹性成像定量参数预测乳腺癌腋窝淋巴结转移的价值

The value of three-dimensional shear wave elastography quantitative parameters in predicting breast cancer axillary lymph node metastasis

目的:探讨三维剪切波弹性成像(three-dimensional shear wave elastography,3D-SWE)技术定量参数预测乳腺癌腋窝淋巴结状态的价值。方法:选取2019年3月—2020年9月于大连医科大学附属大连市中心医院手术且均有病理学检查及免疫组织化学结果证实的乳腺癌患者121例共121个结节。测量乳腺肿瘤3D-SWE的3个正交切面(横断面、矢状面、冠状面)的定量参数最大弹性值(E_(max))、平均弹性值(E_(mean))和弹性数据离散度值(E_(sd))、病灶与周边组织比值(E_(ratio))值,分析乳腺肿瘤的3D-SWE定量参数与其腋窝淋巴结状态的相关性。结果:121例患者,腋窝淋巴结阳性39个,阴性82个,两组间分析结果显示,肿瘤大小、肿瘤钙化、病理学类型,以及乳腺肿瘤的3D-SWE E_(max)、E_(sd)、E_(ratio)两组间差异均有统计学意义(P<0.05)。年龄、绝经状态、肿瘤位置、3D-SWE E_(mean)值两组间差异无统计学意义(P>0.05)。以病理学检查结果为“金标准”,绘制受试者工作特征(receiver operating characteristic,ROC)曲线。二维超声、3D-SWE定量参数及二者联合诊断腋窝淋巴结转移的曲线下面积(area under curve,AUC)分别为0.609、0.735、0.744,二维超声与3D-SWE定量参数差异有统计学意义(P=0.047)。3D-SWE横断面、矢状面、冠状面定量参数E_(max)、E_(sd)、E_(ratio)值间AUC差异均无统计学意义(P>0.05)。结论:乳腺肿瘤的3D-SWE定量参数预测其腋窝淋巴结优于二维超声,二者结合互为补充,本研究结果有望为临床制订治疗方案及预测预后提供有价值的信息。

Objective:To investigate the value of three-dimensional shear wave elastography(3D-SWE)in predicting axillary lymph node status of breast cancer.Methods:From March 2019 to September 2020,121 breast cancer patients with 121 nodules confirmed by pathology and immunohistochemistry were selected in Dalian Central Hospital affiliated to Dalian Medical University.Maximum elasticity(E_(max)),mean elasticity(E_(mean)),elastic standard deviation(E_(sd))and ratio elasticity(E_(ratio))values of three orthogonal sections(cross section,sagittal plane and coronal plane)of 3D-SWE were measured,and the correlation between 3D-SWE quantitative parameters and axillary lymph nodes of breast cancer was analyzed.Results:Among 121 cases,39 axillary lymph nodes were positive and 82 were negative.The results of the analysis between the two groups showed that the tumor size,tumor calcification,pathological type,3D-SWE E_(max),E_(sd),and E_(ratio) values of breast tumors were significantly different(P<0.05).There were no significant differences between in age,menopausal status,tumor location,3D-SWE E_(mean) values between the two groups(P>0.05).The receiver operating characteristic(ROC)curve was drawn based on the pathological diagnosis of axillary lymph node metastasis.The area under curves(AUC)of two-dimensional ultrasound,3D-SWE quantitative parameters and their combined diagnosis of axillary lymph node metastasis were 0.609,0.735,and 0.744,respectively.The difference between two-dimensional ultrasound and 3D-SWE quantitative parameters was statistically significant(P=0.047).3D-SWE cross-section,sagittal plane,coronal plane quantitative parameters E_(max),E_(sd),E_(ratio) values were not statistically different in AUC(P>0.05).Conclusion:3D-SWE quantitative parameters predict breast cancer axillary lymph nodes better than conventional ultrasound.The combination of the two complements each other provides valuable information for clinically determining treatment options and predicting prognosis.